Effectiveness of Alternating Heat and Cold Therapy on Pain and Labor Duration Among Primigravida: A Randomized Controlled Trial.

BACKGROUND

Childbirth is often accompanied by significant discomfort and pain, making effective pain management an essential component of obstetric care. Due to the adverse effects of pharmacological methods, non-pharmacological options such as alternating heat and cold therapy are increasingly recognized for improving the birthing experience by reducing pain and shortening labor. This study aimed to assess the effect of alternating heat and cold therapy on labor pain and the duration of the active first stage of labor between experimental and control groups.

METHODS

A randomized controlled trial was conducted among 106 primigravida admitted to Bharatpur Hospital, Chitwan, Nepal. Participants were randomly assigned to the intervention group (n = 53), who received alternating heat (38-40 ℃) and cold (0-5 ℃) water bags applied to the lower back, or to the control group (n = 53), who received standard care. Labor pain was measured using a visual analogue scale (VAS) at 4-5 cm, 7-8 cm, and 9-10 cm cervical dilation. Data were analyzed using descriptive and inferential statistics in SPSS.

RESULTS

The mean age of participants was 24.23 ± 3.83 years in the intervention group and 23.15 ± 4.16 years in the control group. In the intervention group, mean labor pain scores decreased significantly from baseline to the last assessment (8.79 ± 1.09 to 6.77 ± 0.97, p < 0.001, Friedman test), whereas in the control group, pain increased slightly over time (8.51 ± 0.84 to 8.74 ± 0.65). The duration of the active first stage of labor was significantly shorter in the intervention group (5.09 ± 1.27 hours) compared to the control group (6.05 ± 1.79 hours; p = 0.012, t-test).

CONCLUSION

Alternating heat and cold therapy effectively reduced both pain intensity and the duration of labor in primigravida compared with standard care. With further validation, this approach may serve as a practical, non-pharmacological option for managing labor pain and duration.